Determination of Radiography Requirement with Physical Examination in Elbow Trauma

Abstract

Objective: The purpose of this study was to estimate the presence of fracture and to determine radiography requirements through results obtained by evaluating the physical examination findings in elbow injury. Material and Methods: This was a single center prospective study. All patients were evaluated in terms of trauma mechanism, inspection findings, presence of pain at palpation, pain with active movement, circulatory examination and loss of sensation. Sensitivity, specificity, positive and negative predictive value (NPV) were determined for each sign and each examination finding. Results: The study was performed with 47 patients. Fracture was determined in 10 patients (21.2%). Presence of pain at the elbow extansion, forearm supination (FS), medial epicondyle (ME) palpation and forearm pronation tests exhibited high sensitivity (100%, 100%, 90%, and 80%, respectively) and high NPV (100%, 95%, 96.4%, and 91%, respectively) for elbow fracture. These four tests produced significant p values (0.088, 0.012, 0.001, and 0.079, respectively) in elbow fractures. Combining the pain at FS and ME palpation tests exhibited 90% sensitivity, and 96.7% NPV. Conclusions: Positivity on any one of the four tests employed increases the probability of fracture and is sufficient for elbow radiography to be recommended in patients presenting due to elbow injury. However, radiography may not be required if combined FS and ME palpation test findings are negative in this patients.

Keywords

• Elbow fracture
• Physical examination
• Radiography requirement
• Emergency medicine

Dirsek Travmasında Fizik Muayene Bulguları ile Radyografi Gerekliliğinin Belirlenmesi

Abstract

Amaç: Bu çalışmada dirsek travmasında fizik muayene ve dirsek eklem fonksiyonlarını ölçen bazı testlerin yapılması ve bu veriler ışığında hangi hastalarda kırık olabileceğinin değerlendirilmesi amaçlanmaktadır. Gereç ve Yöntem: Bu prospektif klinik çalışmada, tüm hastalar travmanın mekanizması, inspeksiyon bulguları, palpasyon ile ağrı varlığı, aktif hareket ile ağrı varlığı, dolaşım muayenesi ve duyu kaybı açısından değerlendirildi. Tüm semptom ve bulguların sensitivite, spesivite, pozitif prediktif değer ve negatif prediktif değerleri (NPV) istatistiksel olarak belirlendi. Bulgular: Çalışma 47 hasta ile çalışma yürütüldü. Toplamda 10 hastada kırık saptandı (%21,2). Dirsek ekstansiyonu, ön kol supinasyonu, medial epikondil palpasyonu ve ön kol pronasyon testleri ile ağrı varlığının dirsek kırığı için sensitivitesi yüksekti ( sırasıyla, %100, %100,%90 ve %80). Dirsek kırığı için bu 4 testin p değeri anlamlı olarak tespit edildi (sırasıyla, 0.088, 0.012, 0.001, and 0.079 ). Ön kol supinasyonu ve medial epikondil palpasyon testlerinin kombine değerlendirilmesinin sensitivitesi %90, spesifitesi %81 ve NPS’si %96 olarak tespit edildi. Sonuç: Acil servise dirsek yaralanması ile başvuran hastalarda bu 4 testten birinin pozitif olması fraktür olma olasılığını artırmakta olup dirsek grafisi istenmesi için yeterlidir. Bu hastalarda ön kol supinasyon ve medial epikondil palpasyon testleri kombine kullanıldığında sonuç negatif ise radyografi istenmesine gerek olmayabilir.

Keywords

• Dirsek kırığı
• Fizik muayene
• Radyografi gerekliliği
• Acil servis

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